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The influence of training level and practice setting on patterns of primary care provided by nursing personnel
132 order to reduce potential legal liability that may result from certain clinical judgment in terminal situations. This article examines the legal implications involved in the type of medical treatment pertinent to terminal illnesses in final stages and the means by which patients can exercise control of their own death. Of the three legal methods in existence that address this problem, Right-to-Die Legislation, initiated in California, has provided the most effective means for permitting adults to control decisions relating to their own medical care during terminal illnesses, especially in determining the time and manner of death. Right-to-die statutes allow health-care providers, including physicians, to exercise appropriate clinical judgment on terminally ill patients without fear of prosecution. Both living wills and antidysthanasia contracts are legally ambiguous and for this reason have not been widely accepted. Successful implementation of right-to-die statutes will encourage the establishment of a uniform legislative approach in all states, ensuring the patient's right to death with dignity. TRAINING TIlE ItEALTII PROFESSIONAL IN PATIENT COUNSELLING
13) The influence of training level and practice setting on patterns of primary care provided by nursing personnel MOSCOVICE, I. Dept. Health Services, Sch. Public Health Comm. Med., Univ. Washington, Seattle, Wash., U.S.A. J. Commun. Health 4(1), 4-14, 1978 In recent years, midlevel nursing personnel have assumed a more prominent role in primary health care. A study was therefore undertaken to evaluate two factors: 1) the primary-care treatment patterns provided by family nurse practitioners (FNPs) versus registered nurses (RNs); and 2) the effect the practice setting has on these patterns of treatment. The Frontier Nursing Service in rural Leslie County, Kentucky, is a primary health-care service and training center. It was the setting chosen for the study because the nursing staff (FNPs and RNs) manages approximately 80% of the primary care patients at either the hospital outpatient facilities or the district clinics. The patterns of care examined involved the treatment of otitis media and urinary tract infections. The results indicate that the practice setting (hospital versus district clinic) had a greater influence on the pattern of care than did the level of training of the nursing personnel.
14) The experience of an academic as care giver: Implications for education ROACH, M. S. Dept. Nursing, St. Francis Xavier Univ., Nova Scotia, Canada Death Ed. 2(1-2), 99-111, 1978 In this article, a nurse educator relates her experience as a participant in a course Concerning the care of the terminally ill and dying at St. Christopher's Hospice in London, England. She describes the philosophy and the atmosphere of the hospice to explain both the impact the experience had on her personally and the implications for education of those caring for terminally ill and dying patients. The author emphasizes the importance of educators' being aware of the needs of the patients and their families. Educators must also realize the unique personal needs of the care giver. The physical, emotional, and spiritual demands made on those caring for the dying require a strong community of persons who support each other. The author concluded that programs must be designed that prepare both educators and their students in the characteristics specific to the area of death and dying. Appropriate care of terminally ill and dying patients must be realized and developed by those committed to the hospice concept. Educators should have an integral part of this process and should help to develop training programs that provide guidance in the establishment and use of support systems. THE ROLE OF THE HEALTII PROFESSIONAL
15) Motivation and stress experienced by staff working with the terminally ill VACHON, M. L. S. Clarke Inst. Psychiatry, Univ. Toronto, Ontario, Canada Death Ed. 2(1-2% 113-122, 1978 The purpose of this article is to indicate some of the problems staff members may encounter in their care of the terminally ill and to emphasize how the motivation of the staff effects the job stress they experience. It has been noted that with increased involvement comes increased risk, and the more emotionally involved the staff member is with the patient, the more evident the stress. In order to alleviate or minimize the stress, staff members are encouraged to understand their motivation for wanting to work with the terminally ill and to be aware of their personal limitations. Also, it is essential for each individual to achieve a healthy balance between work and an outside life, and to maintain a support system in both the work
PATIENT COUNSELLING A N D HEALTH EDUCATION
13) The influence of training level and practice setting on patterns of primary care provided by nursing personnel MOSCOVICE, I. Dept. Health Services, Sch. Public Health Comm. Med., Univ. Washington, Seattle, Wash., U.S.A. J. Commun. Health 4(1), 4-14, 1978 In recent years, midlevel nursing personnel have assumed a more prominent role in primary health care. A study was therefore undertaken to evaluate two factors: 1) the primary-care treatment patterns provided by family nurse practitioners (FNPs) versus registered nurses (RNs); and 2) the effect the practice setting has on these patterns of treatment. The Frontier Nursing Service in rural Leslie County, Kentucky, is a primary health-care service and training center. It was the setting chosen for the study because the nursing staff (FNPs and RNs) manages approximately 80% of the primary care patients at either the hospital outpatient facilities or the district clinics. The patterns of care examined involved the treatment of otitis media and urinary tract infections. The results indicate that the practice setting (hospital versus district clinic) had a greater influence on the pattern of care than did the level of training of the nursing personnel.
14) The experience of an academic as care giver: Implications for education ROACH, M. S. Dept. Nursing, St. Francis Xavier Univ., Nova Scotia, Canada Death Ed. 2(1-2), 99-111, 1978 In this article, a nurse educator relates her experience as a participant in a course Concerning the care of the terminally ill and dying at St. Christopher's Hospice in London, England. She describes the philosophy and the atmosphere of the hospice to explain both the impact the experience had on her personally and the implications for education of those caring for terminally ill and dying patients. The author emphasizes the importance of educators' being aware of the needs of the patients and their families. Educators must also realize the unique personal needs of the care giver. The physical, emotional, and spiritual demands made on those caring for the dying require a strong community of persons who support each other. The author concluded that programs must be designed that prepare both educators and their students in the characteristics specific to the area of death and dying. Appropriate care of terminally ill and dying patients must be realized and developed by those committed to the hospice concept. Educators should have an integral part of this process and should help to develop training programs that provide guidance in the establishment and use of support systems. THE ROLE OF THE HEALTII PROFESSIONAL
15) Motivation and stress experienced by staff working with the terminally ill VACHON, M. L. S. Clarke Inst. Psychiatry, Univ. Toronto, Ontario, Canada Death Ed. 2(1-2% 113-122, 1978 The purpose of this article is to indicate some of the problems staff members may encounter in their care of the terminally ill and to emphasize how the motivation of the staff effects the job stress they experience. It has been noted that with increased involvement comes increased risk, and the more emotionally involved the staff member is with the patient, the more evident the stress. In order to alleviate or minimize the stress, staff members are encouraged to understand their motivation for wanting to work with the terminally ill and to be aware of their personal limitations. Also, it is essential for each individual to achieve a healthy balance between work and an outside life, and to maintain a support system in both the work
PATIENT COUNSELLING A N D HEALTH EDUCATION